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Strengthen the Evidence for Maternal and Child Health Programs

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Displaying records 1 through 20 (44 total).

American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 394: Cesarean delivery on maternal request. Obstet Gynecol. 2007;110(6):1501. Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Active Management of Labor, Parent Engagement
Intervention Description: N/A
Primary Outcomes: N/A
Study Design: N/A
Significant Findings: N/A
Setting: N/A
Data Source: N/A
Sample Size: N/A
Age Range: Mothers (exact age not mentioned)

American College of Obstetricians and Gynecologists. Safe Prevention of the Primary Cesarean Delivery. Obstetrics & Gynecology. Obstetric Care Consensus. March 2014. Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Educational Material (Provider)
Intervention Description: N/A
Primary Outcomes: N/A
Study Design: N/A
Significant Findings: Yes
Setting: N/A
Data Source: N/A
Sample Size: N/A
Age Range: N/A

National Quality Forum. Playbook for the Successful Elimination of Early Elective Deliveries. NQF Maternity Action Team. 2014. Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Description: N/A
Primary Outcomes: N/A
Conclusion: N/A
Study Design: N/A
Significant Findings: Yes
Setting: N/A
Data Source: N/A
Sample Size: N/A
Age Range: N/A

March of Dimes. 39+ Weeks Quality Improvement. Healthy Babies are Worth the Wait® Preventing Preterm Births through Community-based Interventions: An Implementation Manual. Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material (Provider), Educational Material, Media Campaign (Print Materials, Public Address System, Social Media)
Intervention Description: HBWW is a multi-dimensional, community-based approach to preventing preventable preterm births. In HBWW sites, community health leaders, including hospitals, health departments and local March of Dimes staff partner to work together to implement multiple (bundled) interventions known to impact preterm birth; to improve systems of care in their community so that these interventions reach the patients who need them; and to promote awareness of preterm birth across all the community, including providers, patients and the public. The pilot/demonstration project was built on an innovative, ecological model designed to work in real world settings, where a multitude of factors—not a single intervention— influence outcomes. Like other public health problems, prematurity must be addressed in communities with broader approaches than just medical care. Working with providers, the goal of the project was to move research to practice quickly and effectively. With patients, the teams worked to improve networks of support services that addressed patient needs. For the public, the goal was that everyone, whether grandmothers, friends or business leaders, understood the impact of prematurity on families and the community.
Primary Outcomes: N/A
Conclusion: A lesson learned through the HBWW Kentucky pilot is that data has the power to influence behavior and, therefore, directly affect program success. For example, KDMC staff recognized a problem—a substantial number of pregnant women had substance abuse problems, illustrated by the number of newborns with positive toxicology screens. To address this issue, KDMC staff developed a “plan” to appoint a perinatal social worker to address prenatal substance abuse. The site applied for a March of Dimes community chapter grant and received funding for the perinatal social worker position. The social worker’s objectives (the “do” step) included screening women for tobacco, alcohol and drug use during pregnancy; providing appropriate referrals; and providing continuity of care for high-risk prenatal patients by improving communication between the social services department and private physician practices at the hospital. Staff examined toxicology screens at a woman’s entry into prenatal care and at delivery. Once the social worker was established at the site, women with positive toxicology screens at prenatal care enrollment were less likely to deliver infants with positive toxicology screens than prior to the social worker being available. These findings (“study”) and supporting anecdotal evidence encouraged the hospital system to continue funding the social work position beyond the grant funding period. In addition, the social worker was validated and felt empowered to continue work to reduce substance use during pregnancy. Both of these results are part of the “act” stage in PDSA. As new HBWW programs move forward, program staff should share stories and data with partners to celebrate program success. Outcome measurement and process tracking provide program staff with information on accomplishments. Defining measurable objectives for each HBWW core component in a project’s implementation workplan offers opportunities to track success. Although barriers and roadblocks may exist, small and large wins along the way provide reasons to acknowledge and celebrate project successes. Program staff can share these successes with partners, collaborators and the community and thank them for their support through media efforts and during community outreach activities. Each person working on prematurity prevention makes life better for children, their families and the communities in which they live.
Study Design: Ecological Design Study
Significant Findings: Yes
Setting: Pilot Study based in Kentucky.
Data Source: data collected from the state vital records system prior to project implementation and at follow-up
Sample Size: N/A
Age Range: N/A

California Maternal Quality Care Collaborative. Elimination of Non-Medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age: A California Toolkit to Transform Maternity Care. August 2011. Access Abstract

The Robert Wood Johnson What Works for Health Project. http://www.countyhealthrankings.org/roadmaps/what-works-for-health. Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Description: N/A
Primary Outcomes: N/A
Conclusion: N/A
Study Design: N/A
Significant Findings: N/A
Setting: N/A
Data Source: N/A
Sample Size: N/A
Age Range: N/A

Agency for Healthcare Research and Quality. Strategies to Reduce Cesarean Birth in Low- Risk Women. Comparative Effectiveness Review Number 80. 2012. Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Active Management of Labor, Quality Improvement/Practice-Wide Intervention, Midwife
Intervention Description: We included studies published in English from 1968 to February 2012. We excluded publications that did not address a Key Question, were not an eligible study design, or did not aim to reduce cesarean birth among low-risk women.
Primary Outcomes: N/A
Conclusion: No single strategy was uniformly successful in reducing cesareans. Strength of evidence was low to insufficient for all strategies. No approach dominated as a strategy appropriate to reduce use of cesarean among low-risk women in the United States.
Study Design: Systematic Review
Significant Findings: No
Setting: N/A
Data Source: searched MEDLINE® via PubMed and the Cumulative Index of Nursing and Allied Health Literature as well as the reference lists of included studies.
Sample Size: 97 studies
Age Range: N/A

Altimier L, Straub S, Narendran V. Improving outcomes by reducing elective deliveries before 39 weeks of gestation: a community hospital's journey. Newborn & Infant Nursing Reviews. 2011;11(2):50-55. doi:10.1053/j.nainr.2011.04.011 Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Chart Audit and Feedback, Guideline Change and Implementation, Organizational Changes, Peer Review, Quality Improvement
Intervention Description: To improve quality and safety of care to our obstetric and neonatal patients (presenting between 34 0/7 and 36 6/7 weeks) by lowering the overall induction rate, lowering the elective induction rate less than 39 weeks, decreasing the unanticipated admissions of late preterm infants to the special care nursery (SCN), decreasing the number of transports out of our level II SCN to a higher level III neonatal intensive care unit, and increasing safety culture scores of the Family Birth Center staff at Mercy Hospital Anderson, Cincinnati, OH.
Conclusion: In 2007, outcomes including total induction rate, elective induction rate for less than 39 weeks, cesarean birth rate for elective inductions among nulliparas, and SCN unanticipated admissions of infants 34 0/7 to 36 6/7 weeks' gestation (late preterm infants) were compared with these same measures in 2005.
Study Design: QE: pretest-posttest
Significant Findings: Yes
Setting: 1 level-II maternity hospital in Ohio
Target Audience: Nulliparous women who gave birth between January 2005 to December 20072
Data Source: Not specified
Sample Size: n=2,172
Age Range: Not Specified

Bergstrom M, Kieler H, Waldenstrom U. Psychoprophylaxis during labor: associations with labor-related outcomes and experience of childbirth. Acta Obstet Gynecol Scand. 2010;89(6):794-800. Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Psychoprophylaxis, PATIENT/CONSUMER
Intervention Description: To study whether use of psychoprophylaxis during labor affects course of labor and experience of childbirth in nulliparous women.
Conclusion: Psychoprophylaxis may reduce the rate of emergency cesarean section but may not affect the experience of childbirth.
Study Design: RCT
Significant Findings: Yes
Setting: 15 antenatal clinics
Target Audience: Nulliparous women with a planned vaginal delivery who gave birth after recruitment at antenatal clinics between October 2005 and January 2007
Data Source: Not specified
Sample Size: n=857
Age Range: Not Specified

Blomberg M. Avoiding the first cesarean section-results of structured organizational and cultural changes. Acta Obstet Gynecol Scand. 2016;95(5):580-586. doi:10.1111/aogs.12872 Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Midwifery, PROVIDER/PRACTICE, HOSPITAL, Chart Audit and Feedback, Organizational Changes, Quality Improvement, POPULATION-BASED SYSTEMS, Community — Outreach, Outreach, COMMUNITY, COMMUNITY
Intervention Description: To improve quality of care by offering more women a safe and attractive normal vaginal delivery. The target group was primarily nulliparous women at term with spontaneous onset of labor and cephalic presentation.
Conclusion: The CS rates have declined after implementing the nine items of organizational and cultural changes. It seems that a specific and persistent multidisciplinary activity with a focus on the Robson group 1 can reduce CS rates without increased risk of neonatal complications.
Study Design: Time trend analysis
Significant Findings: Yes
Setting: 1 public, medium-sized tertiary level obstetric unit
Target Audience: Nulliparous women who gave birth between January 2006 and October 2015
Data Source: Not specified
Sample Size: n=~900 (880-924) per year
Age Range: Not Specified

Cammu H, Eeckhout E. A randomised controlled trial of early versus delayed use of amniotomy and oxytocin infusion in nulliparous labour. Br J Obstet Gynaecol. 1996;103(4):313- 318. Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Active Management of Labor, PROVIDER/PRACTICE
Intervention Description: To compare routine amniotomy and early intravenous oxytocin (active management of labour) with a more selective use of amniotomy and oxytocin in women in true labour who received comparable continuous supportive midwifery care.
Conclusion: Within a set-up of strict labour diagnosis and supportive midwifery care, routine amniotomy and early use of oxytocin offered no advantage over a more selective use of amniotomy and oxytocin in terms of mode of delivery and labour duration.
Study Design: RCT
Significant Findings: No
Setting: 1 urban teaching hospital
Target Audience: Nulliparous women who gave birth after enrollment between January 1993 and March 1994
Data Source: Not specified
Sample Size: Total (n=306) Intervention (n=152) Control (n=154)
Age Range: Not Specified

Campbell DA, Lake MF, Falk M, Backstrand JR. A randomized control trial of continuous support in labor by a lay doula. J Obstet Gynecol Neonatal Nurs. 2006;35(4):456-464. doi:10.1111/j.1552-6909.2006.00067.x Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Labor Support, PROVIDER/PRACTICE
Intervention Description: To compare labor outcomes in women accompanied by an additional support person (doula group) with outcomes in women who did not have this additional support person (control group).
Conclusion: Providing low-income pregnant women with the option to choose a female friend who has received lay doula training and will act as doula during labor, along with other family members, shortens the labor process.
Study Design: RCT
Significant Findings: No
Setting: 1 women’s ambulatory care center at a tertiary hospital in New Jersey
Target Audience: Nulliparous women who gave birth after enrollment between 1998 and 2002
Data Source: Not specified
Sample Size: Total (n=586) Intervention (n=291) Control (n=295)
Age Range: Not Specified

Davey MA, McLachlan HL, Forster D, Flood M. Influence of timing of admission in labour and management of labour on method of birth: results from a randomised controlled trial of caseload midwifery (COSMOS trial). Midwifery. 2013;29(12):1297-1302. Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Continuity of Care (Caseload)
Intervention Description: To explore the relationship between the degree to which labour is established on admission to hospital and method of birth.
Conclusion: These findings that women allocated to caseload care were admitted to hospital later in labour, and that earlier admission was strongly associated with birth by caesarean section, suggest that remaining at home somewhat longer in labour may be one of the mechanisms by which caseload care was effective in reducing caesarean section in the COSMOS trial.
Study Design: RCT
Significant Findings: No
Setting: 1 large, tertiary maternity hospital
Target Audience: Nulliparous women with a planned vaginal delivery who gave birth after recruitment between September 2007 and June 20102
Data Source: Not specified
Sample Size: n=1,532
Age Range: Not Specified

Davis LG, Riedmann GL, Sapiro M, Minogue JP, Kazer, RR. Cesarean section rates in low- risk private patients managed by certified nurse-midwives and obstetricians. J Nurse Midwifery. 1994;39(2):91-97. Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Midwifery
Intervention Description: This study was designed to assess the impact of selected medical interventions during labor upon cesarean section rates by comparing the maternal and neonatal outcomes of obstetrician- and nurse-midwife-managed low-risk private patients.
Conclusion: Women cared for by nurse-midwives had a lower cesarean section rate, fewer interventions, and equally good maternal and infant outcomes when compared with those cared for by physicians.
Study Design: Retrospective cohort
Significant Findings: Yes
Setting: 1 women’s hospital in Illinois
Target Audience: Nulliparous women who gave birth between January 1987 and December 19902
Data Source: Not specified
Sample Size: Total (n=4,827) Intervention (n=322) Control (n=4,505)
Age Range: Not Specified

Dickinson JE, Paech MJ, McDonald SJ, Evans SF. The impact of intrapartum analgesia on labour and delivery outcomes in nulliparous women. Aust N Z J Obstet Gynaecol. 2002;42(1): 59-66. Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Continuity of Care (Caseload), Epidural Analgesia, Midwifery
Intervention Description: To determine if nulliparous women intending to have epidural analgesia have a similar labour profile and delivery outcome to women who intend to have their labour managed using alternative forms of pain relief.
Conclusion: The duration of labour was shorter in the CMS group compared with EPI (10.7 hours (inter quartile (IQ) 7.0,15.2) versus 11.4 hours (IQ 8.2,15.2), p = 0.039). The median duration of the first stage was 8.9 hours (IQ 6,12.5) versus 9.5 hours (IQ 7,12.7) (p = 0.069), and the median duration of the second stage was 1.33 hours (IQ 0.6,2.5) versus 1.48 hours (IQ 0.77,2.6) (p = 0.034). The requirement for oxytocin augmentation in spontaneous labour was 39.8% CMS versus 46.2% EPI (p = 0.129). There was no significant difference in the caesarean section rates. The need for any operative delivery was significantly lower in CMS (43.9% CMS versus 51.5% EPI, p = 0.019).
Study Design: RCT
Significant Findings: No
Setting: 1 tertiary obstetric institution
Target Audience: Nulliparous women who gave birth between May 1997 and October 1999
Data Source: Not specified
Sample Size: Total (n=992) Intervention (n=499) Control (n=493)
Age Range: Not Specified

Eide BI, Nilsen AB, Rasmussen S. Births in two different delivery units in the same clinic--a prospective study of healthy primiparous women. BMC Pregnancy Childbirth. 2009;9:25. doi:10.1186/1471-2393-9-25 Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Midwifery
Intervention Description: The aim of the present study was to compare intervention rates associated with labour in low-risk women who begin their labour in a midwife-led unit and a conventional care unit.
Conclusion: We did not find evidence that starting delivery in the midwife-led setting offers the advantage of lower operative delivery rates. However, epidural analgesia, pudental nerve block and episiotomies were less often while non-pharmacological pain relief was often used in the midwife-led ward.
Study Design: QE: pretest-posttest non-equivalent control group
Significant Findings: No
Setting: 1 university hospital
Target Audience: Nulliparous women who gave birth between November 2001-May 2002 (intervention group) and October 2002 (control group) and did not express desire for epidural analgesia at admission to hospital3
Data Source: Not specified
Sample Size: Total (n=453) Intervention (n=252) Control (n=201)
Age Range: Not Specified

Eriksen, LM, Nohr EA, Kjaergaard H. Mode of delivery after epidural analgesia in a cohort of low-risk nulliparas. Birth. 2011;38(4):317-326. doi:10.1111/j.1523-536X.2011.00486.x Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Epidural Analgesia
Intervention Description: The aim of this study was to explore associations between epidural analgesia and mode of delivery.
Conclusion: In nulliparous women of a very low-risk population, use of epidural analgesia for labor pain was associated with higher risks of emergency cesarean section and vacuum extraction.
Study Design: Prospective cohort
Significant Findings: Yes
Setting: 9 labor wards
Target Audience: Spontaneously laboring nulliparous women who gave birth after recruitment between May 2004 and July 2005
Data Source: Not specified
Sample Size: Total (n=2,721) Intervention (n=588) Control (n=2,133)
Age Range: Not Specified

Eriksson SL, Olausson PO, Olofsson C. Use of epidural analgesia and its relation to caesarean and instrumental deliveries-a population--based study of 94,217 primiparae. Eur J Obstet Gynecol Reprod Biol. 2006;128(1-2):270-275. doi:10.1016/j.ejogrb.2005.10.030 Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Epidural Analgesia, PROVIDER/PRACTICE
Intervention Description: To investigate the association between epidural analgesia for labour-pain relief and mode of delivery.
Conclusion: This investigation shows no clear association between epidural use and caesarean section or instrumental delivery, indicating that there is no reason to restrict the epidural rate to improve obstetric outcome.
Study Design: Retrospective cohort
Significant Findings: No
Setting: 52 delivery units (all)
Target Audience: Nulliparous women who gave birth, excluding elective cesarean deliveries, between 1998 and 2000
Data Source: Not specified
Sample Size: n=94,217
Age Range: Not Specified

Fenwick J, Toohill J, Gamble J, et al. Effects of a midwife psycho-education intervention to reduce childbirth fear on women's birth outcomes and postpartum psychological wellbeing. BMC Pregnancy Childbirth. 2015;15:284. doi:10.1186/s12884-015-0721-y Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Intensive Therapy
Intervention Description: Higher rates of obstetric intervention and caesarean section (CS) are experienced in fearful women. The efficacy of interventions to reduce childbirth fear is unclear, with no previous randomised controlled trials reporting birth outcomes or postnatal psychological wellbeing following a midwife led intervention. The outcomes of the RCT on obstetric outcomes, maternal psychological well-being, parenting confidence, birth satisfaction, and future birth preference were analysed by intention to treat and reported here.
Conclusion: Following a brief antenatal midwife-led psycho-education intervention for childbirth fear women were less likely to experience distressing flashbacks of birth and preferred a normal birth in a future pregnancy. A reduction in overall CS rates was also found. Psycho-education for fearful women has clinical benefits for the current birth and expectations of future pregnancies.
Study Design: RCT
Significant Findings: No
Setting: 3 antenatal clinics in three teaching hospitals
Target Audience: Nulliparous women with measured fear of childbirth who gave birth after recruitment between May 2012 and June 20132,4
Data Source: Not specified
Sample Size: Total (n=104) Intervention (n=51) Control (n=53)
Age Range: Not Specified

Frigoletto FD, Lieberman E, Lang JM, et al. A clinical trial of active management of labor. N Engl J Med. 1995;333(12):745-750. doi:10.1056/nejm199509213331201 Access Abstract

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Childbirth Education Classes, PROVIDER/PRACTICE, Active Management of Labor, Labor Support, Midwifery
Intervention Description: Active management of labor is a multifaceted program that, as implemented at the National Maternity Hospital in Dublin, is associated with a lower rate of cesarean delivery than the rate usually found in the United States. We conducted a randomized trial to evaluate the efficacy of this approach in lowering the rate of cesarean section among women delivering their first babies.
Conclusion: Active management of labor did not reduce the rate of cesarean section in nulliparous women but was associated with a somewhat shorter duration of labor and less maternal fever.
Study Design: RCT
Significant Findings: No
Setting: 1 women’s hospital
Target Audience: Nulliparous women who gave birth between June 10, 1991 and October 17, 1993
Data Source: Not specified
Sample Size: Total (n=1,915) Intervention (n=1,009) Control (n=906)
Age Range: Not Specified

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This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.